Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 26487 | AZ |
NPI | 1588651301 |
---|---|
Provider Name | Jeffrey J. Dyer |
First Address | Phoenix, AZ 85054-5155 |
Second Address | Phoenix, AZ 85054-5155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 19/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
433417 | (05) | AZ |
AZ0779390 | BLUE CROSS BLUE SHIELD (01) | AZ |
G71425 | (02) | |
P00042703 | MEDICARE RAILROAD (01) | AZ |